Fertility preservation in young women

By MD, MSc (gynecologist), BSc, PhD (senior embryologist), BSc, MSc (embryologist), MD (gynecologist), BSc, MSc (embryologist) and BSc, MSc (psychologist).
Last Update: 11/22/2021

Female fertility preservation is a procedure in which the woman's eggs are removed and frozen for preservation over time. In this way, the woman will be able to use these eggs at a later date to become pregnant, without having lost their quality over the years.

Women may decide to preserve their fertility for various reasons, such as prior to cancer treatment. However, in this article, we will focus on egg cryopreservation to delay childbearing, especially for social and work-related reasons.

Although there are many women who make the decision to preserve their fertility after the age of 30, when their desire to become a mother is already more evident, the ideal would be to freeze the eggs before the age of 30, when the woman is at her peak fertility stage.

Why delay childbearing?

In recent years there has been a considerable increase in the number of women who decide to preserve their fertility in order to become mothers in the future. According to the latest data published by the Spanish Fertility Society (SEF), 5,264 egg vitrification cycles took place in Spanish clinics in 2017, about 12% of total assisted reproduction treatments. However, we cannot confirm that all these cycles were performed for the purpose of fertility preservation to delay childbearing.

The main reason for wanting to delay the arrival of a first child is obvious. Many women today are unwilling or unable to become mothers in their early 20s. However, this is the time with the greatest reproductive potential in a woman's life. There is therefore an asynchrony between the optimal age to become a mother and the desired age to become a mother.

Some of the reasons for delaying childbearing are as follows:

  • Insertion of women into the labor market.
  • Difficulty in obtaining a permanent contract and job stability.
  • Study for competitive examinations, doctorates or other higher studies that imply entering the labor market at an older age.
  • “Talent drain", for example, women who move abroad with the purpose of acquiring experience or better working conditions, and who decide not to have children until they can return to Spain.
  • Lack of economic stability, rising rent and other factors that make it impossible to afford the costs of having a child.
  • Lack of male partner.
  • Few family reconciliation measures in the workplace, such as flexible working hours, teleworking, reduced working hours, etc.
  • Women's desire to enjoy their youth without the responsibilities of having a child (traveling, going out with friends, etc.)

Ultimately, each woman may have her own particular reason for deciding not to have children until later in life. However, it is vitally important to be aware and well informed of the reproductive options that allow this delay in childbearing without affecting the likelihood of pregnancy.

Age for egg freezing

Depending on the age at which a woman decides to preserve her fertility, the quality of her eggs will be higher or lower. Therefore, the probability of achieving a pregnancy with these eggs will also vary.

After the age of 35, female fertility decreases dramatically. The ovarian reserve begins to deplete more rapidly and, therefore, women who preserve their fertility between the ages of 35 and 40 will have fewer and poorer quality eggs. It is very important to make women aware that the earlier fertility preservation is done, the more chances of success they will have in the future. Freezing eggs at 20 is not the same as freezing them at 30, just as preserving them at 30 is not the same as preserving them at 40.

According to a recent study conducted at IVI, 24% of women between 30-34 years of age have anti-Müllerian hormone levels related to a decreased ovarian reserve. This percentage decreases to 12% in women under 30 years of age, but increases to 33% in women over 35 years of age.

The main handicap of this is that few women consider becoming mothers or preserving their fertility before the age of 30 or 35, either due to lack of knowledge or lack of economic resources.

Egg vitrification treatment is not cheap and most young women prefer to invest their money in other things rather than in preserving their fertility.

However, at InviTRA we insist on the importance of being well informed about all reproductive options for women, especially if you have a clear desire to become a mother at some point in your life.

Procedure

The treatment to freeze or vitrify the eggs is the same as in vitro fertilization (IVF), since in both cases the aim is to obtain a good number of eggs developed in the ovaries in order to extract them.

Therefore, the treatment steps to preserve fertility in women are as follows:

Consultation with the gynecologist
before starting the whole process it is necessary to do some diagnostic tests to know the fertility status, such as an ultrasound and a blood test.
Controlled ovarian stimulation
consists of the administration of hormonal drugs in order to provoke multiple follicular development in the ovaries and thus obtain the largest possible number of eggs.
Stimulation control
during the entire treatment, the woman will have to visit the clinic several times for ultrasound checks to verify that the ovarian follicles are growing correctly. Depending on the response, the gynecologist may make changes in the schedule of medication administration.
Follicular puncture
this is a very simple surgical procedure that is performed under sedation so that the woman does not feel any pain. Through an aspiration needle introduced through the vagina, the gynecologist extracts the eggs from the interior of the ovarian follicles. This procedure usually only takes about 15 minutes.
Egg retrieval and decumulation
once in the laboratory, an embryologist will inspect the follicular fluid obtained under the microscope and retrieve all the eggs. Next, it is necessary to perform an oocyte decumulation. This consists of eliminating the cells found around the eggs to leave them completely "peeled", a prerequisite for freezing.
Vitrification
this would be the last step of the procedure and requires great skill on the part of the embryologist. First, the eggs are dehydrated with cryoprotectants to avoid any damage during freezing. These are then carefully placed on a support and placed directly into liquid nitrogen at -196°C.

Vitrification is the most widely used method for freezing eggs and embryos today. This is a type of ultra-rapid freezing that offers very high survival rates. In addition, no ice crystals are formed, which would be detrimental to the oocytes.

If you want to know more about this procedure, you can continue reading here: What is egg vitrification and what are its advantages?

How much does fertility preservation cost?

The price of fertility preservation egg vitrification is between approximately €2,500 and €4,000, although this depends on the particular fertility clinic, the services included in the budget, the maintenance fee, etc.

For example, it should be noted that hormone medication is usually paid for separately. As for maintenance fees, most clinics include the costs of the first year or two in the initial budget. The patient will then have to bear the cost of maintaining the frozen eggs, which is about 300-400€ per year.

If you are considering freezing your oocytes to have a baby in the future, we recommend that you get your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Nowadays, assisted reproduction clinics are starting to offer fertility preservation programs that can be affordable for younger women. These are long-term financing programs so that the patient only pays about €30-40 per month, but for about 6-10 years.

At InviTRA we recommend you to get information about this type of personalized program in different centers in order to compare prices and conditions before deciding. If you need help with this, you can continue reading the following article: How to choose the best assisted reproduction clinic for me?

Future: IVF with vitrified eggs

Once a woman wants to use her cryopreserved eggs to become pregnant, she will have to undergo IVF treatment with vitrified eggs.

The procedure is much simpler since the woman has already gone through the ovarian stimulation phase when she froze the eggs. It will only be necessary for your partner to come to the fertility clinic to leave a semen sample, unless you opt for donor sperm.

In the laboratory, the eggs will be devitrified using a very simple protocol and then fertilized with sperm using the ICSI technique (intracytoplasmic sperm injection).

The embryos obtained will spend 3-5 days in culture and, finally, the embryo transfer to the woman will be performed. Those embryos that are not transferred will be vitrified again for future attempts.

FAQs from users

Why is fertility preservation discouraged for older women?

By María de Riva García BSc, MSc (embryologist).

Fertility preservation treatment is recommended for the following type of cases:

  • Women with endometriosis, genetic or autoimmune diseases, or who are going to receive any chemotherapy or radiotherapy treatment.
  • Patients with low ovarian reserve.
  • Patients who are going to postpone childbearing.
  • Patients with low ovarian reserve.
  • Patients who are going to undergo ovarian surgery.

The most advisable age to perform fertility preservation is to do it before the age of 35, since from that age, the quality of the eggs decreases considerably. As a woman's age increases, the quantity and quality of eggs decreases rapidly, especially after the age of 38. Eggs from older women are more likely to have some genetic and chromosomal alteration. Therefore, women 40 years of age and older will have poorer oocyte quality and low ovarian reserve.

However, this depends on each patient, and each case must be reviewed individually, since there are older women (37-39) in whom this fertility preservation treatment can be beneficial.

Is it better to preserve eggs or embryos if I am over 35 years old?

By Dra. Alicia Francos Pérez MD, MSc (gynecologist).

Although the technique of oocyte vitrification has improved greatly in recent years, it still has some shortcomings and a percentage of cryopreserved oocytes may be lost upon devitrification. However, in the case of cryopreserved embryos, the possibility of losing them in devitrification is lower. Therefore, if we only look at the technical side, the answer to this question would be that it is better to cryopreserve embryos rather than oocytes.

But before making the decision to undergo IVF treatment in order to cryopreserve embryos, we must bear in mind that the objective of cryopreservation, in this situation that arises, is to postpone motherhood, and the woman or couple who wish to cryopreserve embryos must consider the possibility that their personal situation may change in the future.

In the case of couples, they must take into account that the embryos are affiliated to both parents, so that, in the event of a separation of the couple, the woman would not be able to dispose of them freely, having to obtain the consent of the man to use them, taking into account that the fruit of the gestation would be affiliated to him, that is to say, they would be his children.

In the case of single women who wish to preserve embryos generated with donated sperm, they should also consider the option of finding a partner in the future, in which case, unless they still maintain an adequate ovarian reserve, they would not be able to have biological children together.

In short, embryo cryopreservation is a technique with a better rate of results, but it is not free of future problems in the event that the woman's social conditions change when the time comes to use them.

How are eggs frozen?

By Emilio Gómez Sánchez BSc, PhD (senior embryologist).

Many women decide to preserve their fertility by cryopreserving their eggs for various reasons, either because they do not wish to become mothers at this time or because they are going to undergo very aggressive treatments, such as chemotherapy or radiotherapy, which may end their oocyte reserve.

Vitrification is the technique used to cryopreserve oocytes, as it has proven to be much more efficient than any other. It prevents ice crystals from forming inside the cells and destroying them. Oocyte vitrification offers better results when it is done in young women, since their oocytes have a higher quality, and therefore, more capacity to fertilize and develop good embryos. The older the age of the patient, the poorer the oocyte quality and the more anomalies.

How many eggs need to be frozen?

By Emilio Gómez Sánchez BSc, PhD (senior embryologist).

Several studies recommend that the number of oocytes that should be stored is between 20 and 25 if the woman is under 35 years of age. If this age is exceeded, a greater number should be vitrified, since there will be fewer good quality oocytes. Although it should always be made clear to the patient that these cryopreserved oocytes will give her the possibility of performing in vitro fertilization in the future, and that she will have a high possibility of achieving a pregnancy, but this is not 100%.

Once vitrified, the eggs can be stored indefinitely.

Is it necessary to be thin to preserve fertility?

By Zaira Salvador BSc, MSc (embryologist).

Not necessarily, although it is recommended to have an adequate Body Mass Index (BMI) to obtain a greater number of eggs and avoid possible risks. A normal BMI is between 18 and 25.

Women who are overweight or obese are more likely to suffer infertility, since estrogen production is affected, among other things. In addition, for ovarian stimulation in obese women a higher dose of hormones is needed to obtain a good response. There is also a greater probability of obtaining immature and poorer quality eggs.

If you want to learn about other fertility preservation methods, both in women and men, you can access the following post: Fertility preservation.

If you need more information about ovarian reserve and how age affects female fertility, we recommend reading the following article: What is ovarian reserve and how does it affect fertility?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Argyle CE, Harper JC, Davies MC. Oocyte cryopreservation: where are we now? Hum Reprod Update. 2016 Jun;22(4):440-9.

Callejo J. Preservación de la fertilidad en la paciente oncológica. ED. Glosa 2009. The Practice Committes of the ASRM and teh SART. Madure oocyte criopreservation: a guideline. Fertil. Steril. 2012.

Camus A. Fertility preservation in female patients. Revista Médica Clínica Las Condes. 2010;21(3):440-449

Garcia Velasco JA et al. Five years' experience using oocyte vitrification to preserve fertility for medical and non-medical indications. Fertil.Steril. 2013

Patrizio P, Molinari E, Caplan A. Ethics of medical and nonmedical oocyte cryopreservation. Curr Opin Endocrinol Diabetes Obes. 2016 Dec;23(6):470-475.

Notas de prensa IVI. 21 noviembre 2019. Más de un 20% de mujeres entre 30 y 34 años presentan una baja reserva ovárica. (ver)

FAQs from users: 'Why is fertility preservation discouraged for older women?', 'Is it better to preserve eggs or embryos if I am over 35 years old?', 'How are eggs frozen?', 'How many eggs need to be frozen?' and 'Is it necessary to be thin to preserve fertility?'.

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Authors and contributors

Dra. Alicia Francos Pérez
Dra. Alicia Francos Pérez
MD, MSc
Gynecologist
Dr. Alicia Francos has a degree in Medicine from the University of Salamanca and a Master's degree in Mastology and Breast Pathology from the Autonomous University of Madrid and another Master's degree in Human Fertility from the Complutense University of Madrid. She also has a diploma in Gynaecological Endoscopic Surgery from the Université Clermont Ferrand. More information about Dra. Alicia Francos Pérez
License: 330840199
 Emilio Gómez Sánchez
Emilio Gómez Sánchez
BSc, PhD
Senior Embryologist
Bachelor's Degree in Biology from the University of Seville. PhD in Biology from the University of Valencia. Large experience as an Embryologist Specialized in Assisted Reproduction. Currently, he is the IVF Lab Director of Tahe Fertilidad. More information about Emilio Gómez Sánchez
License: 14075-MU
 María de Riva García
María de Riva García
BSc, MSc
Embryologist
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
MD
Gynecologist
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
BSc, MSc
Psychologist
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman

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